“And suddenly it became clear to him that what was tormenting him and would not be resolved was suddenly all resolved at once….He sought his old habitual fear of death and could not find it. Where was it? What death? There was no more fear because there was no more death. Instead of death there was light…. For him all this happened in an instant and the significance of that instant never change. Something gurgled in his chest; his emaciated body kept twitching. Then the gurgling gradually subsided. “It’s finished” someone said over him. He heard these words and repeated them in his soul. “Death is finished” he said to himself, “It is no more”. He drew in air, stopped at mid-breath, stretched out, and died”.
Leo Tolstoy, Death of Ivan Ilyich7
The borderline between life and death has been the subject of many writers’ imagination. One such author who dwelt on this subject many times, in keeping, it has to be said, with his often-macabre views of humanity, was the American poet and storyteller Edgar Allan Poe. His tale of The Premature Burial commences with the statements:
The boundaries which divide Life from Death are at best shadowy and vague. Who shall say where one ends, and where the other begins? We know that there are diseases in which occur total cessation of all the apparent functions of vitality, and yet in which these cessations are merely suspensions, properly so called. They are only temporary pauses in the incomprehensible mechanism. A certain period elapses, and some unseen mysterious principle again sets in motion the magic pinions and the wizard wheels. The silver cord was not for ever loosed, nor the golden bowl irreparably broken. But where, in the meantime, was the soul?
Edgar Allan Poe, The Premature Burial8
His tale of mesmerism (hypnotism) at In Articulo Mortis (at the moment of death) makes interesting reading, but too gruesome to examine here.
It is too early to say what this century’s philosophers and writers will have to say about the value of increased longevity now that we have significant capability to extend life, or how the merits of quality and quantity of life compare. It also must be recognized that there are many factors other than clinical and technological competence that come into play here in the determination of longevity, especially including the socio-economic parameters relating to the costs of extended lives.
This uncertainty about the role of technology in both improving the quality of life and extending longevity provides the essential rationale for this book, which, as the title implies, addresses the many facets of our ability to reconstruct the human body. We are now able to keep a heart beating when the patient has already been considered to have end-stage heart failure, to treat a patient for several years with dialysis when they have end-stage kidney disease, and we can maintain individuals who are in a coma or the persistent vegetative state with a good degree of physical well-being for a long time. For purposes of improving life quality, we can replace arteries, joints, teeth, corneas, valves, skin, and many other tissues. Control of heart arrhythmias and Parkinsonian tremors may be achieved with implantable electronic